SPECIFICS OF OBSTRUCTIVE SLEEP APNEA SYN DROME IN POSTMENOPAUSAL WOMEN: LITERATURE REVIEW

LAÍS DE OLIVEIRA LIMA, ROBERTA SILVA DE PAOLA, VITOR HEINEN GANASSIN

Resumo


Introduction: Obstructive sleep apnea (OSA) is a breathing disorder with increased prevalence in women
after the menopause. However, the prevalence is still significantly lower in menopausal women than in
men when adjusted for age and body mass index. Using clinical criteria and polysomnography, the
prevalence was found to be 1.2% in women and 3.9% in men. The main feature of OSA is the presence of
repetitive episodes of upper airway obstruction during sleep, leading to recurrent hypoxia and
hypercapnia, with consequent activation of chemoreceptors and alteration of autonomic nervous system
activity, which influences in development of comorbidities. Objectives: The purpose of this study is to
conduct a systematic review of obstructive sleep apnea syndrome in postmenopausal women to improve
the treatment and the quality of life of these patients. Material and Methods: We conducted a systematic
literature review from the following online databases: Lilacs, Medline, SciELO and PubMed. During the
analysis and selection of the work, were considered the information in the texts, statistical significance,
consistency and results presented by the authors. Results: Studies show that differences in sleep
architecture, ventilation control, presence of obesity and anatomy of the upper airways seem to influence
the incidence of differences found between genders. Martins et al found that apnea is present in women
with arterial values of CO2 much lower than in men, which is especially related to circulating female
hormones. It is believed that progesterone is responsible for an increase in ventilatory response to
hypoxia and hypercapnia, which influences the high threshold for the onset of apnea in women. Among
the factors that influence the risk of OSA increase in females is perimenopause. According to Hannhart et
al, the decrease in estrogen and progesterone modifies factors such as redistribution of body fat, with a
greater tendency to central fat accumulation, especially in the thoracoabdominal and neck. In addition,
the reduction of progesterone modifies muscle tone in the upper airways, leading to a greater tendency
to collapse during sleep. Polysomnography studies show that women after menopause have an increased
latency to sleep onset and difficulty to keep it, having less sleep efficiency. Bixler et al showed that, among
women presenting OSA, 100% of premenopausal women were obese, as were 100% of postmenopausal
women undergoing hormone replacement therapy. Discussion and Conclusion: We can conclude that,
women with OSA when compared to men are usually more obese, have a tendency to develop less severe
sleep apnea and have higher impairment of sleep efficiency. In relation to sleep apnea, female hormones
are protective and male hormones are harmful. Despite the relationship between hormone therapy (HT)
and quality of sleep is still controversial, studies have shown that the use of TH led to improved quality of
sleep in women after menopause. The results point to the need of greater attention to sleep disorders in
postmenopausal women and greater need of investments in detailed studies to follow and adequately
treat these patients.


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